Goa College of Engineering

Farmagudi, Ponda, Goa – 403401

New Student Registration Form

(All the information required to fill in capital letters only)

Name of Student: ______

(in CAPITAL LETTERS As appear in HSSC)

Father Name : ______

Mother Name : ______

Admission Date:______

Admission to Degree : B.E. / M.E.

Branch : ______Batch: 2011-12

Stateof Eligibility (Goa, GOI, etc) :______

Bank Name : ______BankAccount No.: ______

Fee Payment Type : General / Fee Concession 50% / Fee Concession 30% / AICTE Tuition Fee Waiver Scheme

Date of Birth : ______Place of Birth: ______

Admission Category: ______Caste :______

Religion : ______Nationality : ______

Mother tongue: ______Blood Group : ______

E-mail ID : ______

Father Occupation : ______

Mother Occupation : ______

Identification Marks : ______

Sex : Male / Female Married : Yes / No

Height in CM : ______Weight in KG : ______

Name of Exam. : ______

Board of Exam. : ______

Name of School: ______

Exam Seat No. : ______Total Marks Obtained: ______Maximum Marks:______

Passing Month : ______Year: ______Percentage Marks Scored: ______Grade:______

(Note: Attach attested Photocopy of 10thstd marks card)

Name of Exam. : ______

Board of Exam. : ______

Name of School: ______

Exam Seat No. : ______Total Marks Obtained: ______Maximum Marks:______

Passing Month : ______Year: ______Percentage Marks Scored: ______Grade:______

(Note: Attach attested Photocopy of 12thstd marks card)

candidate should fill the details of marks obtained in each individual subjects at HSSC/ 12th std examinations in the following table/ candidate seeking Direct second year admission can write diploma/degree subjects and marks in the table

Subjects / Marks Obtained / Maximum Marks
English
Physics
Chemistry
Mathematics
Biology
Computer Science
Others
Others

Address : ______

______

City : ______Pin : ______Dist. : ______State : ______

Parent’s Landline phone No.: ______Parent’s Mobile No.: ______

Candidate’s Mobile No:______E-mail Id: ______

Nearest Bus Station: ______Railway Station : ______

Address : ______

______

City : ______Pin : ______Dist. : ______State : ______

Parent’s Landline phone No.: ______Parent’s Mobile No.: ______

Candidate’s Mobile No:______E-mail Id: ______

earest Bus Station: ______Railway Station : ______

Guardian Name: ______Guardian Occupation : ______

Relation with Guardian: ______Guardian E-mail ID :______

Address : ______

______Pin : ______

Landline No.: ______Mobile No.:______

Last Exam Name : ______Exam Year : ______

Board or Univ. Name : ______Duration of Year : ______

Total Marks Obtained : ______Total Max. Marks : ______Percentage of Marks : ______

Class : ______

GCET Roll No.: ______Year of Exam: ______Category:______Rank: ______

GCET/G2CET* Marks

GCET Rank/G2CET* Rank: ______Roll No______Year of Exam______

Obtained Marks / Max Marks
Physics
Chemistry
Mathematics
Biology
Computer Science

* For direct second year admission

I hereby declare that the particulars furnished above are true, complete, and correct to the best of my knowledge and belief.

Date:

Place:Signature of Student

Instructions:

  1. 10th std and 12thstd attested photocopy of marks sheet to be attached with this form.
  2. The photocopy of admit card to be attached with this registration form
  3. Affix passport size colour photograph at the space provided in the form
  4. Additional sheet can be attached to provide diploma/degree level exam details
  5. Candidate changing branches/courses/ in the subsequent admission round are require to compulsorily submit this form along with REGISTRATION SSLIP issued by the college during the first time registration
  6. Candidates changing college/cancelling admissions should compulsorily submit letter of intimation to college failing which the fees and certificates will be withheld till the clearance from the admission authority
  7. Candidate should submit notarized copy of Annexture I (affidavit by the student) and Annexure II (affidavit by parent/guardian) at the time of registration at college.

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